Colorectal Archives - Laparoscopic surgeon

Apr 22 Comments Off

Incontinence treatment and symptoms

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What is incontinence?

Do you have a frequent or sudden need to urinate or you can’t control your bladder? You may have this common condition known as urinary incontinence which is more commoner among the female gender.

Types of urinary incontinence:

Stress incontinence is when urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.

Urge incontinence is if you have a sudden, intense urge to urinate followed by an involuntary loss of urine, you may need to urinate often. Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as neurologic disorder or diabetes. Urge incontinence is also called overactive bladder, spastic bladder or reflex incontinence.

Overflow incontinence is when you experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.

Functional incontinence is where a physical or mental impairment keeps you from making it to the toilet in time.

Symptoms of incontinence are — feeling a sudden need to urinate or feeling a frequent need to urinate (more than 7 times a day or 2 times a night), weak bladder control and leaking. Some people experience occasional, minor leaks of urine. Others wet their clothes frequently.

What are the main causes for incontinence?

Diseases like diabetes, Parkinson’s and multiple sclerosis (MS) can damage the nerves that control your bladder.

Vaginal childbirth, recurrent urinary tract diseases, strokes, surgeries and treatments for pelvic cancers can also cause urinary incontinence.

What are the treatment options available for this condition?

Treatment depends on what kind of incontinence you have and how bad your symptoms are. There are four main treatment approaches for incontinence which include bladder and pelvic floor muscle training, lifestyle changes, medications, surgery and bladder retraining.

For Urge incontinence– Practices like double voiding (urinating and wait for another few minutes and doing again), toilet trips which involves 2-3 hourly scheduled toileting rather than waiting

until an urge arises and proper fluid and dietary management play a major role in reaching a symptomatic improvement.

Behavioral modification therapy is the therapy where an urologist might suggest techniques like limiting the amount of fluid you drink, eliminating caffeine because it irritates your bladder or bladder training, which will teach you to hold your urine longer and doing exercises to strengthen your pelvic floor.

Both Stress incontinence and Urge incontinence can be treated effectively with Electrical stimulation which enhances the tone and strength of pelvic floor muscles.

Furthermore, medications like Anticholinergics, Mirabegron (Myrbetriq), Alpha blockers and topical estrogens can also be used to address symptoms in all the three types.

Is there any place for surgical treatments?

In patients who do not respond to any of the conservative or pharmacological management, can be treated with surgical interventions like Sling procedures, bladder neck suspension, prolapse surgery and artificial urinary sphincter fixation, depending on the etiology

Apr 22 Comments Off

Dietary Precautions For Anal Fistula

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What you eat is what you are, especially when it comes to taking care of your internal organs like, stomach, liver, intestines, rectum, etc. your diet reflects their health. Conditions like anal fistula can be prevented with a healthy diet and lifestyle.

What is an Anal fistula?

Anal fistula is defined as an abnormal communication between the epithelial surface of the anal canal and the perianal skin. Anal fistula usually initiates with a tissue damage.

Patients with this condition usually are present with,

A constant pain in the area, throbbing in nature which gets worsen on sitting down.
A chronic irritation of the skin associated with swelling, redness and tenderness around the anus.
A smelly discharge of pus with or without blood
Constipation
Pain on bowel movement
Mild to moderate fever

In acute stage, a fistula can be extremely painful and may bleed frequently but if ignored for a long time for more than 7-8 months, it gets partially healed up and a skin growth known as sentinel tag or sentinel pile surrounds it.

What are the causative factors for Fistula?

In most of the individuals, anal fistulae usually develop following an anal abscess. Untreated abscesses in the anal area or ones which have not healed completely can give rise to fistula.

In fact, research studies have put forward a fact that one in every two-four people with an anal abscess have the chance of developing an anal fistula, later in life.

There is also a significant male predominance between the ages 20-40 years.

Other less common causes for anal fistula include,

Crohn’s disease
Diverticulitis
Hidradenitis Suppurativa
Tuberculosis

How anal fistula can be prevented through diet?

Diet plays a major role in improving this condition. Furthermore, since constipation is one of the major reasons for the exacerbation of anal fistula, it is highly important to control it as much as possible using dietary remedies.

Take adequate dietary fibers such as bran, beans, passion fruit, berries, green leaves, mushrooms, banana, cabbage etc.
Eat more vegetables, fruits and salad.
Avoid gluten-free junk food, French fries, potato chips, processed meat and refined grains.
Drink plenty of water and fluids but avoid much coffee and tea.
Avoid straining during defecation (especially while constipation)
Avoid excessive oils, chilies and spices in food items.
Avoid much of non-veg. food. Try to be vegetarian.
Use of buttermilk (Lassie without butter) with a pinch of cumin powder and black salt keeps the digestion correct

How do you manage anal fistula?

Prevention is the best treatment. Maintaining a good nutritional habit is a great way to maintain health issues and ward off fistulas. In addition, abstaining from smoking is important to promote fistula healing.

Are there any specific dietary measures to be taken?

Apart from the general precautions mentioned above, it is recommended to refrain from alcohol and smoking since they are known to play a major role in exacerbating the signs and symptoms of anal fistulae

In addition, you can take dietary advice from a dietician or the specialist to choose the best schedule of meals, depending on the individual requirements and severity of the condition.

Apr 22 Comments Off

VAAFT: Best Anal Fistula Treatment

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Video Assisted Anal Fistula Treatment, also known as VAAFT is so far the newest and most advanced surgical intervention introduced for Fistula-in-ano. This procedure is usually done under general anesthesia, where a tiny telescope is entered through the external opening of the site of the skin where the fistula-in-ano is located. The HD-camera of latest technology attached to the other end, thereby visualizes the inner aspect of the fistula pathway on a HD- monitor and the surgeon will remove the complete length of the fistula with the help of precise visualization up to its inner opening, located on the wall of the anal canal.

More importantly, this method can also detect abnormal branching patterns of the fistula tracts and carry on the necessary therapeutic techniques at the same time. After the complete removal of the fistula, the internal opening is closed with the help of either sutures or staplers, preventing the leakage of stools back in to the fistula tract and the entire canal is sealed off using a mild electric cautery. Some surgeons may also use fibrin or cynao-acrylate glue in order to obliterate the fistula pathway.

At the end gentle flushing of the wound with normal saline is done followed by a routine dressing at the site of fistula removal.

This method is highly encouraged, in order to clean dead tissue left inside the fistula tunnel so that it will result in a proper and quick healing.

What are the advantages of VAAFT:

In this procedure, an incision is not made on the skin around the anus and therefore there is no visible scars unlike in other major surgeries.
Being a camera guided and very precise procedure, no damage is caused to the muscles around the anus which are responsible in controlling bowel movements. As a result, possible adverse effects like bowel incontinence and leakage are highly unlikely when compared to other open surgeries done.
Due to the minimal invasive nature of VAAFT and the lack of excisions, wounds or scar formation, the pain caused after the wearing off of anesthesia is very mild or negligible.
Complete removal of the fistula is guaranteed since the whole procedure is being done under direct visualization of the canal. As a result of that, the incidence of recurrence is very rare.
Since VAAFT is known to be a day surgery, patient will be discharged on the same day of the surgery after wearing off of anesthesia.
Complete and quick healing of the wound will take place within a few days compared to that of a normal open surgery so patient can get back to his day to day life relatively in a short period of time.
According to several research studies carried out, the technique of VAAFT has been accepted world-wide as a very efficient intervention made on fistula-in-ano, with a 100% success rate.
More importantly, the cost of VAAFT is comparatively lower than what is expected for normal open surgery, so in patient’s point of view it is a huge benefit.

Dr Nitish Jhawar, head of colorectal department at Fortis Hiranandani Hospital Vashi , Navi Mumbai has been trained for VAAFT procedure at Germany by the inventor Dr P.Meinero and he offers this procedure along with other latest treatments for Fistula in Ano.

Apr 22 Comments Off

Esophageal Manometry : Diagnosing Disorders Affecting your Esophagus (Food pipe)

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Esophageal Manometry is a procedure which is used to identify various pathological conditions associated with the esophagus (food pipe) and lower esophageal sphincter (LES), the valve like ring of muscle, located between the esophagus and stomach. This valve is responsible in controlling the movements taking place when food bolus is passed through the esophagus to the stomach and improper functioning of it can result in condition like acid reflux or gastro esophageal reflux disease (GERD).

Patients who present with symptoms such as acid regurgitation, heart burn, chest pain (which mimic heart attack), difficulty or pain in swallowing, nausea and vomiting can be advised to go for esophageal manometry. It is also done Prior to anti reflux surgery.

Before esophageal manometry eight hour or over-night fasting is advised by the Gastroenterologist. In addition to that, a complete history including current medications and past surgical history will be taken from the patient where certain drugs like calcium channel blockers, nitrates, nitroglycerin and sedatives might have to be withdrawn for a certain duration.

Patient will be lied down on bed, and an application to numb the nasal canal (anesthetized) is applied which will help in reducing the discomfort throughout the procedure.

Thereafter, a very thin and flexible tube is inserted into the nose which will pass down the esophagus until it reaches the stomach and when it is pulled back gradually, the patient is asked to swallow at different points so that the individual pressures and tone of the esophageal muscles and lower esophageal sphincter is measured by sensors attached to the tube. This test is also used to measure the pH value of the esophageal contents with the help of the pH probe attached to the same tube.

This whole procedure takes approx 30 to 45 minutes.

It is normal that some patients may gag or feel uncomfortable when the tube is inserted initially and get a stuffy nose during the procedure. However, breathing is not interfered by the procedure.

Major complications of esophageal manometry include perforation, where a trauma to the esophagus might have caused a hole on it resulting in leakage and aspiration where an inhalation of saliva or some other contents in the stomach takes place which can give rise to pneumonia and lung injuries.

The results obtained by esophageal manometry will help to diagnose problems such as abnormal contractions of esophageal muscles, Achalasia cardia (improper opening of LES), Hiatus Hernia and GERD (weak LES), spasmodic movements of the esophagus and Scleroderma (an autoimmune condition which will paralyze muscles of esophagus).

Methods of treatment will be planned based on the type and severity of the conditions diagnosed by esophageal manometry.

Esophageal Manometry is useful test to diagnose food pipe movement and pressure disorders and is available at colorectal department of Fortis Hiranandani hospital Vashi , Navi Mumbai, headed by Dr Nitish Jhawar.

Apr 22 Comments Off

Effectiveness of Neurotoxin-Botox Injection for Anal Fissure

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Anal fissure is a common condition which occurs due to the increased pressure in the internal anal sphincter located in the anal canal. Being this condition could affect all age groups, especially young adults and the main presenting complaints include pain in the anal area on defecation and bleeding per anus.

Acute anal fissures are usually treated conservatively either with life-style modifications like increased dietary fiber and water intake or using over the counter medications like stool-softening agents (Laxatives). Some Patients are also advised to use Sitz baths, local anesthetic ointments and Glyceryl trinitrate which will ease the pain on defecation and eventually heal the fissure completely.

Chronic anal fissures, do not respond to this kind of treatments and may require surgical interventions.

Botox injection (a neurotoxin) is a latest yet, very safe and efficient method of treatment used in patients with anal fissures and commonest indication for the procedure includes chronic idiopathic anal fissure uncomplicated by other anal conditions. It is also known to be involved with a very simple technique which can be carried out in the outpatient department (OPD), without the requirement of sedation or local anesthesia.

How botox Injection works on anal fissure?

An elevated resting pressure in the anal sphincter muscles due to their hyper-tonicity (increased tone) is known to be the major cause for anal fissures to develop. This will result in a disruption of blood supply to the anal mucosa, since the blood vessels which are responsible in distributing blood to the distal anal canal are being pressurized by the increased tone of sphincter muscles, creating a chronic anal fissure.

Botox injection which contains a neurotoxin, will paralyze the internal anal sphincter on a temporarily basis and thereby decrease its tone and spasms which obstruct the blood supply to the distal anal canal. With proper perfusion and nourishment, the fissure will heal over time and symptoms will disappear. The effect of the toxin will last for about two to three months, which is usually enough for an uncomplicated fissure to resolve.

This method can be expensive yet, cost effective since it will lead to complete healing of the fissure without having to go through the risk of bowel incontinence, complications of anesthesia and wound infections which may occur as a result of lateral internal sphincterotomy surgery. More importantly, the technique used and the site of injection are independent of patient’s age, gender and the location of internal sphincter ring.

Although, there are no major side effects of Botox injections, some patients may complain of minor reversible bowel leakage (incontinence), inability to control passage of air (gas incontinence), pain caused by the injection, bleeding or hematoma formation and infections at the site of injection.

Regular follow-ups are encouraged to see the response to the treatment and improvement of symptoms and patients who do not show any positive results even about eight weeks following the Botox injection or experience complicated fissures creating severe symptoms, will have to consult colorectal surgeon or surgical gastroenterologist and undergo a surgery.

Apr 22 Comments Off

Diet Precautions for Piles

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Piles, or Haemorrhoids, is the condition where blood vessels around the rectum swell. This often results in pain, itching and bleeding, and also possibly resulting in prolapse (protrusion of the inner vessels) in more serious cases.

Early Piles often may heal on its own with adequate home care and self-help measures. Over-the- counter medicines can be used for the swelling and warm tub baths can help with the pain. However apart from these, one of the most important things to keep in mind is to avoid straining during bowel movements as it can aggravate the condition immeasurably. This is why patients having haemorrhoids need to adhere carefully to the dietary precautions in order to avoid constipation. Without it, piles might worsen to the extent of needing surgery. Read more about colorectal surgery: Gall Bladder Stone

Lifestyle changes such as a healthy diet and regular exercise can thus make an enormous difference to people suffering from piles. Key diet precautions that patients need to follow are:

Include High Fibre food

High fibre food helps in digestion and ensures regular bowel movements. The fibre from food adds bulk to your stools, make it softer thus enabling you to pass stools regularly without any strain. The ideal amount of fibre recommended per day for adults is 20 to 30 gms

To get this, your diet must include sufficient amounts of whole grain, lentils, fruits, vegetables and nuts. These provide you with not just the necessary dietary fibre but also essential nutrients. Doctors, in fact, recommend a minimum of 4.5 cups of fruits and vegetables every day.

Some of the recommended items are: Fruits such as Apples, pears, papaya, and vegetables like green leafy vegetables, cabbage, carrots, beetroots etc.

However, you must make sure to introduce food with the high fibre slowly into your diet so as to avoid cramps, stomach upsets and gas.

Avoid Processed Food

Processed food such as chips, burgers, freezer meals, pizzas although convenient do not contain any fibre and are also poor in nutrients. A diet which is predominantly made of processed food usually leads to constipation, which aggravates haemorrhoids. Doctors, therefore, advise patients suffering from piles to reduce junk food.

Avoid Refined Grains

Refined grains such as white bread, pasta are very low in dietary fibre and nutrients. Include whole grain items such as oatmeal, whole wheat pasta, brown rice to boost the amount of fibre in your meals.

Avoid Processed Meat

Patients suffering from piles must ideally avoid a diet that is meat-heavy since animal meat does not contain fibre. Processed animal meat is worse since apart having no fibre, it usually contains very high levels of salt, fat and sugar.

Increase Intake of water

Increased water consumption is helpful in softening the stools and to add bulk as the fibre in your digestive system absorbs the water and enlarges in size. This helps in the easy passage of stools. It is recommended to drink at least 8-10 glasses of water per day. Other recommended liquids that can be consumed include fruit juices and green tea, but avoid too much of caffeine.

Apr 22 Comments Off

Colorectal Cancer: Detection and Treatment

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There are various measures that may tell you if you are suffering from colon cancer that includes alteration of bowel habits (diarrhea, constipation etc) lasting for several days, continuous feeling that you need to go for bowel movement which doesn’t occur, dark stools with blood, rectal bleeding, abdominal pain, sustaining weakness and fatigue etc. It is highly advised that if you are suffering from any such symptoms then consult Gastroenterologist or Colorectal surgeon immediately.

Diagnosis

Certain tests may be recommended for screening of colorectal cancer.

FOBT (Fecal Occult Blood Test) is done to examine for the hidden blood in stool.
Sigmoidoscopy- through Sigmoidoscope the lower and rectum colon is tested to detect cancerous or any precancerous growth. They are further tested or removed for more clarity.
Colonoscopy- through colonoscope the entire colon and rectum is tested to detect the presence of cancerous or any precancerous growth. They are further tested or removed for more clarity.
Virtual or computerized tomography colonoscopy- through a special X-ray equipment 3-D pictures are taken out of colon and rectum and later through the arrangements of these pictures by computer shows detailed information about any abnormalities and polyps.

Treatment

Among the various methods of treating colorectal cancer, three standard treatments are:

1) Surgery – it could be called as the most effective measure as the cancer affected zone is removed through this treatment. It is highly recommended for treating local colorectal tumors.

During colonoscopy a small tumor may be removed but removing the entire area with the surrounding fats and lymph nodes is undoubtedly the best way to treat. This surgery may be performed by open surgery method or by laparoscopy as suggested by your doctor.

In a process called colostomy the waste product is collected in a bag placed over stoma which is an opening made by surgeons. After the healing of bowel colon and rectum is reconnecting through another operation. In rectal cancer permanent colostomy is essential.

Painkillers along with medicines are often provided to the patients after operation to get relief from the pain.

Nutritious foods which are rich in protein and calories are advised to the patient to heal faster.

2)Chemotherapy – this treatment for cancer utilizes drugs to arrest the growth of cancerous cells by killing them or restricting them from further division. The drugs consumed through injection or mouth directly hits the bloodstream and reach cancer cells and when it is taken through spinal column it affect the area having cancer cells.

Combination of Xeloda (Capecitabine), Oxaliplatin, 5-fluouracil and Camptosar (Irinotecan) are used to treat the diverse stages of this cancer. Directly the chemotherapy may be provided to the liver if the cancer is metastasized there. The five drugs Cetuximab (Erbitux). Bevacizumab, ziv-aflibercept, panitumumab and regorafenib is approved by FDA for treating this cancer. These drugs together arrest the protein or blood which is helping in the growth of cancer.

3)Radiation therapy – this therapy utilizes the highly advanced X-Ray or radiation to restrict or kill the cancer cells. Two methods of radiation therapies are there.

The first one is external radiation where the machine is used to send radiation from outside part of the body to the cancer affected area.

The second method called internal radiation therapy utilizes substances of radioactive which are sealed in wires, seeds, catheters, needles and are injected directly on the infected area. It is done after the surgery with the Chemotherapy to kill all the possible existing cancer cells. If the tumor of the patient had stick to another part of the abdomen or if it is present on the point of cancer which was removed then radiation therapy is highly recommended.

You can live a normal life after the treatment as per the advice of the surgeon but remember to keep a regular follow-up as suggested by your healthcare provider.

Apr 22 Comments Off

Question and Answers related to Anal Fissure by Dr. Nitish Jhawar

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Dr. Nitish Jhawar is answering questions related to Anal Fissure in Times of India

Q1. I am 26 yrs old sales executive I had severe constipation after my travel last week ,now feeling severe pain while passing stool and noticed some bleeding also on the tissue while cleaning is it piles ?

A. Most commonly piles cause painless bleeding so if it’s a classical cutting glass pain following defecation with smudging on the tissue or a streak of blood on a stool then it may be Fissure – in – Ano. A simple visit to your surgeon will solve your problem.

Q2. Do fissures always require surgery?

A. The mainstay of treatment is medical which is aimed at reducing the pain, relaxing the anal muscles & curing the constipation surgery can be avoided in many cases.

Q3. If medical treatment fails then is there any other remedy other than conventional surgery?

A. Fissures refuse to heal due to spasm of the sphincter muscle if medical treatment fails then we can actually temporarily paralyze the internal sphincter muscle by injecting BOTOX. It is safe, fast and convenient but fissures may relapse once the muscle gains their normal tone again.

Q4. What is the conventional surgery all about will I lose control over my feces after getting it done?

A. Standard treatment for a fissure is called LIS (Lateral Internal Sphincterotomy) with or without fissure ectomy (excision of the fissure) it comprises of loosening the internal muscle by cutting a part of it. It is the very controlled way of releasing the spasm and there is no long-term effect on the continence.

Q5. Can LASER be done to cure fissures?

A. Yes LASER can be used to treat the fissures it’s a little expensive option but the equally good option as an LIS.

Q6. I recently delivered a baby and now having a painful bleeding from rectum since last 2 weeks do I need surgery as it is difficult to take care of by newborn with this painful condition?

A. It is very common to have fissure problem during or after delivery, medical treatment mostly helps and surgery is required only in nonresponsive cases.

Q7. I am a 40-year-old man I noticed some painful bleeding recently. I looked up on the internet I am scared that it could be Cancer please help?

A. The bleeding from the rectum can very well be a sign of cancer if associated with any of the RED flag signs like weight loss, change in bowel habits, black or tarry stools, anemia, family history of colorectal cancer etc. A short duration fresh bleed is usually not so ominous but visits to a specialist are required to rule out any lurking danger avoid self-medication at all cost.

Apr 21 Comments Off

Lecture on Thinking beyond Piles – Constipation & Obstructive Defecation Syndrome by Dr Nitish Jhawar

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Dr Nitish Jhawar Director colorectal surgery & Laparoscopic surgeon at fortis Hiranandani hospital Vashi delivered a lecture on 13th dec 2015 on “Thinking beyond Piles – Constipation & Obstructive Defecation Syndrome” at D. Y Patil Hospital, Nerul, navi Mumbai.

Talk was attended by members of Indian Association of Occupational Health.

Normally colorectal problem could be more than just piles, anything at anal area is normally taken as piles by general public, so dr nitish jhawar spoke about piles , fistula, anal fissure and constipation and obstructive defecation syndrome. A very common problem yet very few people take medical guidance.

Obstructive defecation syndrome is characterized by urge to defecate but an impaired ability to expel fecal bolus

Symptoms include unsuccesful evacuation attempts, straining, pain, bleeding and sensation of incomplete evacuation.

Dr Nitish advised that usually constipation is managed by genral home care and healthy life style but ODS a type of constipation in selected patient can be managed by minimally invasive surgery STARR.

Laparoscopic, Robotic and LASER Surgery - GI & Colorectal, Navi Mumbai

All Posts in Category: Colorectal

Incontinence treatment and symptoms

Dietary Precautions For Anal Fistula

VAAFT: Best Anal Fistula Treatment

Esophageal Manometry : Diagnosing Disorders Affecting your Esophagus (Food pipe)

Effectiveness of Neurotoxin-Botox Injection for Anal Fissure

Diet Precautions for Piles

Colorectal Cancer: Detection and Treatment

Question and Answers related to Anal Fissure by Dr. Nitish Jhawar

Lecture on Thinking beyond Piles – Constipation & Obstructive Defecation Syndrome by Dr Nitish Jhawar

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